Any medical professional who could offer their opinion?

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Hi,

my father was admitted to hospital a few months ago with breathing diffficulties. Dad had previously been diagnosed with left ventricular heart failure and pulmonary hobbyists, but these conditions had been relatively well managed. upon arrival at hospital it was found that dad had significant pulmonary edema and was prescribed 240mg of furosemide over 24 hours. The nurse mistakenly administered the entire 240mg dose over 5 hours. Dad’s reveal function was impacted and he lost fluid rapidly- the nurse described his catheter bag as “ looking like a football”.

Dad was informed of this error the following morning and relayed the information to us. My mother, as his next of kin was not contacted at any point and we were only aware due to him telling us.

dads condition worsened and he died 2 weeks later from an acute exacerbation of his pulmonary fibrosis.

We aren’t suggesting that overdose led to his death, however we are concerned that it may have contributed to his suffering in his final weeks. We have submitted a formal complaint and have received a response, however we aren’t convinced that the hospital aren’t minimising the overdose.

Would a 240mg dose of furosemide over short period be considered as a serious breach, and would this have caused dad to suffer unnecessarily?

Thank you

I am not a medical professional.

I do however know enough that most medical professionals would feel that it would be inappropriate for a medical professional to give their professional advice on this forum in this format.

I think you need to find an independent consultant in the relevant field who is entirely unconnected to the trust who runs the area you live in, and pay for a consultation to discuss this with them.

Possible outcomes might be that they are able to give you reassurance that this wasn't a significant factor - you'll only be able to accept that if you can trust the consultant as entirely independent. Or that they will confirm your fears to the point that you may decide to sue the hospital for the unnecessary pain/distress - and obviously consultants will be reluctant to put their career on the line by giving you ammunition for doing that to their employers.

Thank you

I would also ask your self what is the outcome you seek? This may help make the decision to take this further. Mistakes are made in life all the time and whilst your poor dad happened to be in the receiving end of this mistake, chances are he would have passed anyway. His heart and lungs were failing. His kidneys will have needed to work harder to process the urine production from the excess frusemide (diuretic) but I suspect (and I'm not a doctor) it would not have contributed to his death.

I'm sorry for your loss

Also with regards to not telling your mum (as his next of kin) there would be no need to tell her as the patient himself had been informed. Unless he was deemed as incapacitated and mum had power of attorney, the hospital would not tell her as it's private health information and it would have been inappropriate to share that with anyone other than the patient

The error should have been self referred at the time and it subsequently be investigated as an incident.

There is something called Duty of Candour which is why your df was told but this should be followed up in writing and if he lacked capacity next of kin informed.

Agree with above poster - your mum would not have needed to be informed as NOK unless your dad was incapacitated or she held POA over health rights.

As for the dose - although it was given faster than prescribed, it was not given outside of licensing regulations - you can see this in the BNF online which is now available to everyone (the standard that all health care professionals would prescribe and a administer by).

However, if his kidney function was fine on admission, severally impacted after the administration of IV frusomide, this may have had some affect on his pulmonary fibrosis.

I would say you have grounds to complain and push back with any response they give you, however as a previous person has also said you need to decide what you want from the complaint. Is it just an apology letter? Reprimand for the nurse? Direct contact with the nurse for their apology? Etc etc. It may be a long and drawn out process whatever you are looking for.

I am not sure there is going to be an answer to your question and probably a complaint didn't get you the kind of closure you were looking for as the process isn't really set up for it.

LVF and pulmonary fibrosis is a very difficult combination to treat - both are very serious, life-limiting illness and due to the clinical signs they both have it can be difficult/impossible to know which one is needing the most treatment on any given day.

240mg Furosemide is a big dose - which implies your Dad was incredibly sick with not many options left. Prescribing it over 24 hours is also usually a kind of last ditch thing to do.

I am wondering how much communication there was with your mum and yourself about quite how unwell he was and that he might die during the admission. This can be difficult as obviously most of the communication will be with your Dad as he is the patient but for family members you can be left really as you have no time to prepare.

Having made an error, the hospital rightly told you about it but possibly this meant this was the communication focus, rather than your dad being in a life or death situation every day.

Would the hospital be prepared to offer you a meeting with his medical team? Discussing the admission day by day and going through the notes, knowing what they were thinking and responding to may be more helpful for you than getting a complaint response letter.

Sadly there was never anything in writing. We only found out as dad was able to tell us, despite his increasing delerium